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Certification Recommendation Request Form

Please complete this form and submit it if you are a student enrolled in the FINAL semester of a teacher education, school administrator program or school counselor program that leads to NYS Certification. Processing of your form by the Certification Officer will occur when your graduation date has posted to your transcript in Brockportal, there are no holds on your account, and required workshops are confirmed. Please do not submit multiple copies of this form as it will slow down processing time.

  • Today's Date Today's Date * / /
    Pick a date.
  • Name Name *
  • Birthdate Birthdate * / /
    Pick a date.
  • Phone Number Phone Number * - -
  • Degree Type *
    Degree Type
  • Anticipated Month of Graduation *
    Anticipated Month of Graduation
  • Draw or Type
    I understand this is a legal representation of my signature. Clear

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350 New Campus Drive
Brockport, NY 14420